Devices, systems, and methods for anchoring sutures

ABSTRACT

Various devices, systems, and methods for anchoring sutures are provided In general, a suture anchor can include a groove formed in an exterior surface thereof and configured to seat a suture at least partially therein. The suture can be configured to automatically become seated in the groove during the advancement of the anchor into bone, such as by being rotated therein using a driver tool. The suture and the groove can have cooperating sizes such that the suture seated in the groove extends radially outward therefrom to be partially located outside of the anchor. This external portion of the suture can be press fit between the anchor and the bone, thereby securing both the anchor and the suture to the bone. This securing can occur as part of driving the anchor into bone.

FIELD

The present disclosure relates generally to devices, systems, andmethods for anchoring sutures.

BACKGROUND

Implanting anchors with sutures attached is performed in a variety ofdifferent situations, for example in arthroscopic hip labrum surgery orwhen re-attaching tissue to bone in rotator cuff surgery. Currently,anchoring sutures in bone can be a difficult process given the finecontrol required over suture strands, the desire to ensure that anchorsare safely secured in bone, and the minimally-invasive nature of manyapplicable surgeries. Because of the challenges presented by securinganchors in bone while manipulating the suture strands, suture anchorsare often designed to be larger than would be desirable due to, e.g.,the addition of threading around exterior surfaces of anchors and/or theneed to secure the suture to the anchor.

Decreasing the size of suture anchors can allow more precise control incertain anatomical situations, such as placing anchors in the acetabulumduring hip labrum repair or reconstruction surgery and/or to preventloss of valuable room in a surgical site. For example, there can beinterference between threading on adjacent anchors if sufficient spaceis not provided for by the surgeon or allowed for at a particularsurgical site. However, it has been difficult to reduce anchor size dueto the fine control required over suture strands and the desire to addthreading to anchors to ensure a secure placement in bone.

Accordingly, there remains a need for improved devices, systems, andmethods for anchoring sutures.

SUMMARY

In general, devices, systems, and methods for anchoring sutures areprovided.

In one aspect, a surgical system is provided that in one embodimentincludes a suture anchor. The suture anchor is configured to be disposedin bone and has a suture-seating feature at a distal end thereof and hasa helical groove formed in an exterior surface thereof. The groove has amaximum depth, has a length, and is configured to seat a suture at leastpartially therein along the length of the groove.

The surgical system can vary in any number of ways. For example, thehelical groove can be a single continuous groove. In still anotherexample, the helical groove can include a plurality of discrete groovesthat together define a helical shape. As another example, the helicalgroove can have a substantially constant pitch along its length. In yetanother example, the helical groove can have a first pitch in a distalportion of the suture anchor and a second pitch in a proximal portion ofthe anchor, and the first pitch can be greater than the second pitch.For another example, the suture anchor can have a cannulated interior.For yet another example, the groove can have a distal terminal end and aproximal terminal end, the suture-seating feature can include a recess,and the distal terminal end can be at a distal surface of the sutureanchor and in communication with the recess.

For another example, the system can include a suture configured to beseated in the helical groove, and the suture can have a diameter that isgreater than the maximum depth of the groove. In at least someembodiments, the suture can be coupled to the suture anchor and can beconfigured to move from a first configuration, in which none of thesuture is seated in the groove, to a second configuration, in which anintermediate portion of the suture between terminal ends thereof is atleast partially seated in the groove. Additionally or alternatively, inat least some embodiments, the suture can be configured to move from afirst configuration to a second configuration. The suture in the firstconfiguration can have a first length thereof extending longitudinallythrough a cannulated interior of the suture anchor, a second lengththereof extending longitudinally outside the exterior surface of thesuture anchor, and a third length thereof between the first and secondlengths being seated in a suture-seating recess at a distal end of thesuture anchor. The suture in the second configuration can have the firstlength thereof extending longitudinally through the cannulated interiorof the suture anchor, the second length thereof can be seated in thegroove, and the third length thereof can be seated in the suture-seatingrecess. The suture anchor can be configured to be rotated and therebycause the suture to move from the first configuration to the secondconfiguration. The maximum depth of the groove can not be greater thanabout 90% of the diameter of the suture. The system can, in at leastsome embodiments, include a driver tool with a distal end configured tobe disposed within the cannulated interior of the suture anchor, and thedriver tool can be configured to drive the suture anchor into bone whilesimultaneously causing the suture to move from the first configurationto the second configuration.

For another example, the system can include a suture coupled to thesuture anchor and configured to move from a first configuration, inwhich none of the suture is seated in the groove, to a secondconfiguration, in which an intermediate portion of the suture betweenterminal ends thereof is at least partially seated in the groove. In atleast some embodiments, the suture anchor can be configured to berotated about a longitudinal axis thereof and thereby cause the sutureto move from the first configuration to the second configuration.Additionally or alternatively, in at least some embodiments, the systemcan include a driver tool with a distal end configured to be disposedwithin a cannulated interior of the suture anchor, and the driver toolcan be configured to drive the suture anchor into bone whilesimultaneously causing the suture to move from the first configurationto the second configuration. in at least some embodiment, the suture inthe first configuration can have a first length thereof extendinglongitudinally through a cannulated interior of the suture anchor, asecond length thereof extending longitudinally outside the exteriorsurface of the suture anchor, and a third length thereof between thefirst and second lengths being seated in a suture-seating recess at adistal end of the suture anchor. The suture in the second configurationcan have the first length thereof extending longitudinally through thecannulated interior of the suture anchor, the second length thereofseated in the groove, and the third length thereof seated in thesuture-seating recess. The suture anchor can be configured to be rotatedand thereby cause the suture to move from the first configuration to thesecond configuration. The system can, in at least some embodiments,include a driver tool with a distal end configured to be disposed withinthe cannulated interior of the suture anchor, and the driver tool can beconfigured to drive the suture anchor into bone while simultaneouslycausing the suture to move from the first configuration to the secondconfiguration.

In another example, the suture-seating feature can be continuous withthe helical groove. In still another example, the suture-seating featurecan not be continuous with the helical groove.

In another embodiment, a surgical system includes a suture anchor and asuture. The suture anchor has a groove formed in an exterior surfacethereof, and the groove has a maximum depth. The suture has a diameterthat is greater than the maximum depth of the groove such that when thesuture is seated in the groove, the suture protrudes radially outwardfrom the groove.

The system can have any number of variations. For example, the groovecan be a helical groove such that the suture seated in the groovehelically wraps around the suture anchor. For another example, thegroove can be a longitudinal groove such that the suture seated in thegroove extends longitudinally along the suture anchor.

For yet another example, the suture can be configured to move from afirst configuration to a second configuration, where the suture in thefirst configuration has a first length thereof extending longitudinallythrough an inner lumen of the suture anchor and a second length thereofextending longitudinally outside the exterior surface of the sutureanchor, and the suture in the second configuration has the first lengththereof extending longitudinally through the inner lumen of the sutureanchor and the second length thereof seated in the groove. The systemcan, in at least some embodiments, include a driver tool having a distalend configured to be disposed within the inner lumen of the sutureanchor, and the driver tool can be configured to drive the suture anchorinto bone while simultaneously causing the suture to move from the firstconfiguration to the second configuration.

In another example, the suture anchor can have a distal suture-seatingrecess, where a first length of the suture extends longitudinallythrough an inner lumen of the suture anchor, a second length of thesuture extends longitudinally outside the exterior surface of the sutureanchor, and a third length of the suture between the first and secondlengths is seated in the suture-seating recess.

As still another example, the system can include a driver toolconfigured to drive the suture anchor into bone and thereby cause thesuture to move from not being seated in the groove to being seated inthe groove so as to helically wrap around the anchor along at least apartial longitudinal length of the suture anchor. The suture can form acompression fit with the bone when the suture anchor has been driveninto the bone.

In still another example, the maximum depth of the groove can not begreater than about 90% of the diameter of the suture.

In another aspect, a suture anchor is provided that includes a sutureanchor body, a cannulation, and a depression. The suture anchor has alongitudinal axis. The cannulation extends through the body along thelongitudinal axis and is configured to receive a suture therethrough.The depression defines a helical path in an external surface of thesuture anchor, and at least a portion of the depression has a depth lessthan a diameter of the suture.

In another aspect, a surgical method is provided that in one embodimentincludes rotating a suture anchor into bone. The suture anchor has asuture coupled thereto with a first length of the suture extendinglongitudinally through an inner lumen of the suture anchor and a secondlength of the suture extending longitudinally outside the exteriorsurface of the suture anchor. The rotation of the suture anchor causesthe second length of the suture to be seated within a groove defining ahelical path around an exterior surface of the suture anchor and to becompressed between the suture anchor and a wall of the bone.

The method can vary in any number of ways. For example, the groove canbe a single continuous groove, and the second length of the sutureseated in the groove can be a continuous length of the suture. Inanother example, the groove can include a plurality of discrete groovesthat together define the helical path, and the second length of thesuture seated in the groove can include a plurality of discrete lengthsof the suture. In yet another example, the second length of the suturecan be seated in the groove in a distal to proximal direction. Inanother example, the suture anchor can have a third length of the suturebetween the first and second lengths seated in a distal suture-seatingrecess of the suture anchor. In still another example, the second lengthof the suture can be seated in the groove starting at the suture-seatingrecess. In another example, rotating the suture anchor can includerotating a driver tool having a distal end mated to the suture anchor.In yet still another example, the suture can have a diameter that isgreater than a maximum depth of the groove.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a side view of one embodiment of a suture anchor with acontinuous helical groove;

FIG. 2 is a side view of the suture anchor of FIG. 1 with a suturecoupled thereto;

FIG. 3 is a perspective view of one embodiment of a suture anchor withan interrupted helical groove;

FIG. 4 is a cross-sectional top view of the suture anchor of FIG. 3 witha suture coupled thereto;

FIG. 5 is a side view of another embodiment of a suture anchor with acontinuous helical groove and having a suture coupled thereto in a firstconfiguration;

FIG. 6 is a side view of the suture anchor of FIG. 5 with the suture ina second configuration;

FIG. 7 is a side view of yet another embodiment of a suture anchor witha continuous helical groove and having a suture coupled thereto in afirst configuration

FIG. 8 is a side view of the suture anchor of FIG. 7 with the suture ina second configuration;

FIG. 9 is a side view of another embodiment of a suture anchor with alongitudinal groove;

FIG. 10 is a side view of the suture anchor of FIG. 9 with a suturecoupled thereto in a first configuration;

FIG. 11A is a side view of the suture anchor of FIG. 10 with the suturein a second configuration;

FIG. 11B is a top end view of one embodiment of a suture anchor with acontinuous helical groove and a longitudinal groove;

FIG. 12 is a cross-sectional top view of one embodiment of a two-lobedsuture anchor;

FIG. 13 is a cross-sectional top view of one embodiment of a three-lobedsuture anchor;

FIG. 14 is a cross-sectional top view of one embodiment of a four-lobedsuture anchor;

FIG. 15 is a side partially cross-sectional schematic view of oneembodiment of a driver tool disposed within one embodiment of a sutureanchor with a suture coupled to the driver tool and the suture anchor;

FIG. 16 is a side partially cross-sectional schematic view of the drivertool, the suture anchor, and the suture of FIG. 15 with the sutureanchor partially advanced into a bone hole and the suture partiallyseated in a groove of the suture anchor;

FIG. 17 is a side partially cross-sectional schematic view of the drivertool, the suture anchor, and the suture of FIG. 16 with the sutureanchor advanced farther into the bone hole and the suture seated in moreof the groove;

FIG. 18 is a side partially cross-sectional schematic view of the drivertool, the suture anchor, and the suture of FIG. 17 with the sutureanchor advanced farther into the bone hole and the suture seated in moreof the groove;

FIG. 19 is a side partially cross-sectional schematic view of the drivertool, the suture anchor, and the suture of FIG. 18 with the sutureanchor advanced farther into the bone hole and the suture seated in moreof the groove;

FIG. 20 is a side partially cross-sectional schematic view of the drivertool, the suture anchor, and the suture of FIG. 19 with the sutureanchor advanced entirely into the bone hole and the suture seated inmore of the groove; and

FIG. 21 is a side partially cross-sectional schematic view of the sutureanchor and the suture of FIG. 20 with the driver tool removed.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices, systems, and methods disclosedherein. One or more examples of these embodiments are illustrated in theaccompanying drawings. Those skilled in the art will understand that thedevices, systems, and methods specifically described herein andillustrated in the accompanying drawings are non-limiting exemplaryembodiments and that the scope of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. A person skilled inthe art will appreciate that a dimension may not be a precise value butnevertheless be considered to be at about that value due to any numberof factors such as manufacturing tolerances and sensitivity ofmeasurement equipment. Sizes and shapes of the systems and devices, andthe components thereof, can depend at least on the anatomy of thesubject in which the systems and devices will be used, the size andshape of components with which the systems and devices will be used, andthe methods and procedures in which the systems and devices will beused.

Devices, systems, and methods for anchoring sutures are provided. Ingeneral, a suture anchor can include a groove formed in an exteriorsurface thereof and configured to seat a suture at least partiallytherein. The suture can be configured to automatically become seated inthe groove during the advancement of the anchor into bone, such as bybeing rotated therein using a driver tool. The suture and the groove canhave cooperating sizes such that the suture seated in the groove extendsradially outward therefrom to be partially located outside of theanchor. This external portion of the suture can be press fit between theanchor and the bone, thereby securing both the anchor and the suture tothe bone. This securing can occur as part of driving the anchor intobone. The anchor may thus simplify the process of securing sutures inbone by allowing a surgeon to focus on advancing the anchor into thebone while the suture automatically winds itself into the groove tosecure itself and the anchor in the bone. The groove of the anchor mayallow for a reduction in an overall size of the anchor by eliminating orreducing the need to have a thread or other bone-engaging feature suchas barb(s) or rib(s) on the exterior surface of the anchor because thesuture can hold the anchor within bone without the bone-engagingfeatures being present on the anchor's exterior surface. In other words,the suture seated in the groove may provide additional width to theanchor to secure the anchor in the bone as the anchor is advancedtherein, thus allowing for the reduction of the overall size of theanchor.

FIGS. 1 and 2 illustrate one embodiment of a suture anchor 10 thatincludes a helical groove 16. The suture anchor 10 has an inner lumen 14extending therethrough such that the anchor 10 is cannulated. The innerlumen 14 is configured to receive a driver tool (not shown) therein, andis configured to have a suture 12 extend therethrough. Prior to theanchor 10 being driven into bone, the suture 12 can loop through theinner lumen 14 and around to an external surface of the suture anchor 10(as illustrated in FIG. 2).

A suture-engaging feature 18 is formed at a distal end 10 d of thesuture anchor 10. The suture-engaging feature 18 is configured to seatand engage the suture 12 when the suture anchor 10 is driven into bone.When the suture 12 is looped through the inner lumen 14 and around tothe external surface of the suture anchor 10, the suture-engagingfeature 18 seats the suture 12 as the suture 12 extends from the innerlumen 14 to the external surface, which may help ensure that the suture12 is seated in the groove 16 of the suture anchor 10 during driving ofthe anchor 10 into bone, as discussed further below. The suture-engagingfeature 18 illustrated in FIGS. 1 and 2 is a groove or recess formed inthe distal end 10 d of the suture anchor 10 and extending across adiameter of the inner lumen 14. In various other embodiments, thesuture-engaging feature 18 can have other configurations. Examples ofthe suture-engaging feature include a fork on the distal end 10 d′ a barextending across the inner lumen 14 to which the suture can be passed,looped about, tied, etc.; a scalloped groove; a notch in an outer edgeof the distal end 10 d of the suture-engaging feature 10; a loop throughwhich the suture can be passed; an eyelet; a hook; and a crimpingfeature such as a slit that secures the suture to the distal end 10 d bycrimping the suture therein.

The suture-engaging feature 18 in this illustrated embodiment isconfigured to allow the suture 12 to freely slide therein prior to thesuture 12 being press fit against bone, as discussed further below,which may allow for adjustment of the suture 12 relative to the anchor10 before the anchor 10 is driven into one and/or for a suture of aselected size to be coupled to the anchor 10 for a particular surgicalprocedure. In at least some embodiments, the suture-engaging feature 18can be configured to fixedly secure the suture 12 thereto (e.g., bybeing tied to a bar, by being crimped by a crimping feature, etc.) suchthat the suture 12 cannot freely slide relative to the anchor 10 beforeor after the suture 12 is press fit against bone, which may reduce achance of the suture 12 from catching or being misplaced.

The helical groove 16 is formed in the exterior surface of the sutureanchor 10. The helical groove 16 is configured to receive the suture 12and seat the suture 12 therein along a length of the helical groove 16,which in an exemplary embodiment is the entire length of the groove 16.A distal-most end of the helical groove 16 is in communication with thesuture-engaging feature 18 at the distal end 10 d of the anchor 10.Because the helical groove 16 is in communication with thesuture-engaging feature 18, a suture (e.g., the suture 12) that isengaged with the suture-engaging feature 18 will be encouraged to alwaysstart winding at the distal-most end of the helical groove 16 when theanchor 10 is driven into bone and thereby help ensure that the groove 16seats the suture 12 along an entire length of the groove 16.

The helical groove 16 has a maximum depth 16 d, and the suture 12 has adiameter 12 d. In an exemplary embodiment, the diameter 12 d of thesuture 12 is greater than the maximum depth 16 d of the helical groove16. In this way, when the suture 12 is seated in the groove 16, aportion of the suture 12 extends radially outward from the anchor 10.The maximum depth 16 d being less than the diameter 12 d of the suture12 helps ensure the presence of this outward radial extension when thesuture 12 is seated in the groove 16 since the groove 16 is too smallfor the suture 12 to be fully contained within the groove 16. Themaximum depth 16 d of the helical groove 16 being less than the diameter12 d of the suture 12 may allow the suture to be in a press fit when thesuture anchor 10 is driven into bone, as discussed further below. In theillustrated embodiment, the maximum depth 16 d of the helical groove 16is about one-third of the diameter 12 d of the suture 12. The suture 12is thus configured to be seated in the helical groove 16 with aboutone-third of the suture 12 received in the groove 16 and abouttwo-thirds of the suture 12 extending radially outward from the sutureanchor 10. A variety of size relationships between the maximum depth 16d of the helical groove 16 and the diameter 12 d of the suture 12 arepossible. In an exemplary embodiment, the For example, the maximum depth16 d can be up to about 90% of the diameter 12 d, e.g., the maximumdepth 16 d can be up to about 75% of the diameter 12 d, the maximumdepth 16 d can be about one-third of the diameter 12 d, etc.

The suture 12 is a #2 suture with the diameter 12 d being about 1 mm. Avariety of suture sizes can be used in different embodiments, however,such as of suture in a range of a #5 suture to a #5-0 suture. Themaximum depth 16 d of the groove 16 can be sized accordingly to have thedesired size relationship, such as in this illustrated embodiment withthe maximum depth 16 d being about 0.33 mm (about one-third of thesuture's diameter 12 of about 1 mm).

The helical groove 16 is continuous and maintains a substantiallyconstant depth along the external surface of the suture anchor 10, e.g.,the maximum depth 16 d is substantially constant along the groove'slength. A person skilled in the art will appreciate that the depth maynot be precisely constant but nevertheless be considered to besubstantially constant due to any number of factors such asmanufacturing tolerances and sensitivity of measurement equipment. Thedepth of the helical groove 16 can vary in other embodiments so as tonot be substantially constant along the external surface of the sutureanchor 10, such as by varying on one or more sides of the suture anchor10 to an extent that the groove 16 is not continuous, as discussedfurther below, or by varying in depth from a distal to a proximal end ofthe suture anchor 10, e.g., gradually decreasing in depth from adistal-most end of the groove 16 to a proximal-most end of the groove16. The helical groove 16 is a single groove in the illustratedembodiment, but a plurality of helical grooves can be formed in anexterior surface of a suture anchor such that more than one suture canbe engaged and wound up along the suture anchor, one suture in each oneof the grooves. Having a plurality of helical grooves each seating asuture therein may help ensure security of the anchor in bone in theunlikely event of suture failure (e.g., breakage during or afterimplantation, etc.).

A thread pitch (or the distance between threads) of the helical groove16 is constant along a length thereof. However, the thread pitch canvary in other embodiments, such as the helical groove 16 having a firstpitch in a distal portion of the suture anchor 10 and a second, smallerpitch in a proximal portion of the anchor 10. Having the first pitch begreater than the second pitch can allow the anchor 10 to have a“cancellous” thread pitch distally and a “cortical” thread pitchproximally. The first and second thread pitches can be configured forplacement in cancellous and cortical bone respectively, to allow for asmaller pitch positioned in the harder cortical bone and thus for lesssuture to be press fit against the cortical bone than against thecancellous bone due to the greater first pitch and the smaller secondpitch.

The suture anchor 10 has a diameter of about 1.5 mm and a length ofabout 6 mm. However, the size of the suture anchor 10 can vary in otherembodiments, for example having a diameter in a range of about 1.5 to 3mm and a length in a range of about 4 to 10 mm. The suture anchor 10 canbe made from any of a variety of materials, such as Polyether EtherKetone (PEEK), poly(lactide) (PLA), stainless steel, or a bioceramicsuch as Biocryl® Rapide® available from DePuy Mitek, Inc. of Raynham,Mass.

The suture 12 is flexible to allow the suture 12 to wrap around theanchor 10. The suture 12 can be made from any of a variety of materials.For example, the suture 12 can be made of absorbable material such asOrthocord® available from DePuy Mitek, Inc. of Raynham, Mass. or anon-absorbable material such as Permacord or Ethibond® available fromEthicon US, LLC of Somerville, N.J.

The suture 12 is configured to move between a first configuration (shownin FIG. 2) and a second configuration. The first configuration of thesuture 12, an embodiment of which is shown in FIG. 2, is an initialconfiguration of the suture 12 prior to driving of the anchor 10 intobone. The second configuration of the suture 12 is a deployedconfiguration of the suture 12 following the driving of the anchor 10into the bone. As discussed further below, the suture 12 is configuredto automatically move from the first configuration to the secondconfiguration in response to the anchor 10 being driven into bone, e.g.,in response to a driver tool in the inner lumen 14 advancing the anchor10 into the bone.

In the first configuration the suture 12 is substantially not seated inthe groove 16. In this illustrated embodiment, the suture 12 is notseated in the groove 16 at all in the first configuration. In otherembodiments, the suture 12 can be seated in a distal-most end of thegroove 16 to encourage the suture 12 to wrap around the anchor 10 withinthe groove 16, as opposed to outside of the groove 16. For example, thesuture-engaging feature 18 can position the suture 12 within thedistal-most end of the groove 16 by fixing the suture 12 therein withthe suture 12 not being freely slidable relative to the anchor 10 beforeor after the suture 12 is press fit against bone.

When the suture 12 is in the first configuration, the suture 12 can, asshown in FIG. 2, not be seated in the groove 16, e.g., have a firstlength thereof extending through the inner lumen 14 of the suture anchor10, a second length thereof extending outside the exterior surface ofthe suture anchor 10, and a third length thereof between the first andsecond lengths engaged by the suture-engaging feature 18. The first,second, and third lengths of the suture can vary. For example, the firstlength and/or the second length of the suture can be approximatelyequivalent in length to a number of times the helical groove wrapsaround the suture anchor multiplied by a circumference of the sutureanchor. In another example, lengths of the first length and/or thesecond length of the suture can be at least twice as long as the maximumlongitudinal dimension of the suture anchor. When the suture 12 is inthe second configuration, the suture 12 can be at least partially seatedin the groove 16, e.g., have the first length thereof extending throughthe inner lumen 14 of the suture anchor 10, the second length thereofseated in the helical groove 16 of the suture anchor 10, and the thirdlength thereof engaged by the suture-engaging feature 18.

An overall length of the suture 12 can vary. For example, the firstlength and/or the second length of the suture 12 can be about equivalentin length to a number of times the helical groove 16 wraps around thesuture anchor 10 multiplied by a circumference of the suture anchor 10.In another example, lengths of the first length and/or the second lengthof the suture 12 can be at least twice as long as the suture anchor 10.

The suture 12 includes a single suture strand in this illustratedembodiment, but the suture 12 can include one or more suture strands.

The anchor 10 has a tapering outer diameter with a first diameter at thedistal end 10 d thereof that gradually increases toward the proximal end10 p thereof. The anchor 10 having a larger diameter in its proximalportion than in its distal portion may help retain the anchor in bonesince more compression may be achieved between the suture 12 seated inthe groove 16 in the proximal portion than in the distal portion, whichmay help reduce chances of pull-out of the anchor 12 from the bone. Inother embodiments, the anchor 10 can have a substantially constantdiameter along its length.

FIG. 3 illustrates another embodiment of a suture anchor 30 thatincludes an inner lumen 34 extending therethrough and that includes ahelical groove 36. The suture anchor 30 is generally configured and usedsimilar to the suture anchor 10 of FIGS. 1-2. The helical groove 36 isconfigured to receive a suture similar to the helical groove 16, but thehelical groove 36 is an interrupted, non-continuous groove including aplurality of discrete grooves that together define a helical grooveinterrupted with smooth portions of the anchor's exterior surface alongwhich the suture may abut. The groove 36 being interrupted may increasepull-out characteristics of the suture anchor 30 because of the greatercontact allowed between the suture and a bone in which the anchor 30 isdisposed because more of the suture is available to be compressedbetween the suture anchor 30 and the bone where the groove 36 is notpresent. The interrupted groove 36 in this illustrated embodiment isarranged such that two opposite sides of the suture anchor 30 have nogroove and two opposite sides of the anchor 30 have the groove 36 (asillustrated in FIG. 3). The suture can thus be seated in the groove 36except where the groove 36 does not extend, e.g., except along the twosides where the groove 36 is not present. Where the groove 36 is notpresent on the anchor's exterior surface, the suture will sit directlyon the exterior surface of the suture anchor 30. As illustrated in oneembodiment in FIG. 4 in which the anchor 30 is disposed in a bone hole40, this results in a suture 32 helically wrapped around the anchor 30radially extending outward to a greater degree along these sides lackingthe groove 36 than on the sides where the groove 36 is present and thesuture 32 sits in the groove 36.

The groove 36 can have a maximum depth that is less than a diameter ofthe suture 32, as discussed above, such that the suture 32 seated in thegroove 32 extends radially outward therefrom. The suture 32 wound aroundthe anchor 30 in a helical shape can thus be press fit with bone alongits entire helical-shaped length. In other embodiments, the groove 36can have a maximum depth that is equal to or greater than the diameterof the suture 32 such that the suture 32 seated in the groove 36 iscontained in the groove 36 so as to not extend radially outwardtherefrom. In such embodiments, only the portion of the suture 32 woundaround the anchor 30 in a helical shape in the non-grooved portionsthereof would be press fit with bone.

FIGS. 5 and 6 illustrate another embodiment of a suture anchor 200 thatincludes a helical groove 206 in an exterior surface thereof. The sutureanchor 200 is generally configured and used similar to the suture anchor10 of FIGS. 1-2. The anchor 200 has a suture-engaging feature 208 at adistal end of the anchor 200 in the form of an eyelet through which asuture 210 can be passed to couple to the anchor 200. The suture 210extending through the eyelet 208 has each of a first length 210 athereof and a second length 210 b thereof extending along an exteriorsurface of the suture anchor 200. The anchor 200 thus can have but neednot have a cannulated interior, as the suture 210 need not pass throughthe anchor 200 to be coupled thereto. If the anchor 200 is notcannulated, the anchor 200 can have a bore formed in a proximal endthereof to receive a driver tool therein for driving the anchor 200 intobone.

As the anchor 200 is driven into bone, the suture 210 is configured tomove from a first configuration, shown in FIG. 5, in which the suture210 is not seated in the groove 206, to a second configuration, shown inFIG. 6, in which the suture 210 is at least partially seated in thegroove 206. Each of the first and second lengths 210 a, 210 b of thesuture 210 are seated in the groove 206 in the second configuration. Thesuture 210 thus need not have a diameter 210 d greater than a maximumdepth 206 d of the groove 206 in order for the suture 210 to extendradially outward of the groove 206. Instead, the suture 210 can have adiameter 210 d that is less than the maximum depth 206 d of the groove206 where twice a diameter of the suture 210 is greater than the maximumdepth 206 d of the groove 206 to allow the suture 210 having two lengths210 a, 210 b in the groove 206 to extend radially outward of the groove206 and allow for a compression fit of the suture 210 with the bone inwhich the anchor 200 is disposed. The suture 210 can, however, have adiameter 210 d greater than the maximum depth 206 d of the groove 206,which may facilitate a tight compression fit since the suture's lengths210 a, 210 b can be more tightly compressed between the bone and theanchor 200.

FIGS. 7 and 8 illustrate another embodiment of a suture anchor 300 thatincludes a helical groove 304, 306 in an exterior surface thereof. Thesuture anchor 200 is generally configured and used similar to the sutureanchor 10 of FIGS. 1-2 and, similar to the anchor 200 of FIGS. 5 and 6,has a suture-engaging feature 308 at a distal end of the anchor 300 inthe form of an eyelet. The groove 304, 306 in this illustratedembodiment includes two independent helical grooves 304, 306. A suture310 extending through the eyelet 208 has each of a first length 210 athereof and a second length 210 b thereof extending along an exteriorsurface of the suture anchor 200. The suture 310 extending through theeyelet 308 has each of a first length 310 a thereof and a second length310 b thereof extending along an exterior surface of the suture anchor300. The anchor 300 thus can have but need not have a cannulatedinterior, similar to that discussed above regarding the anchor 200 ofFIGS. 5 and 6.

As the anchor 300 is driven into bone, the suture 310 is configured tomove from a first configuration, shown in FIG. 7, in which the suture310 is not seated in either of the grooves 304, 306, to a secondconfiguration, shown in FIG. 8, in which the suture 310 is at leastpartially seated in the first and second grooves 304, 306. In the secondconfiguration, the first length 310 a of the suture 310 is seated in thefirst groove 304, and the second length 310 b of the suture 310 isseated in the second groove 306. A diameter 310 d of the suture 310 isgreater than a maximum depths 304 d, 306 d of each of the helicalgrooves 304, 306, so the suture 310 extends outward from the helicalgrooves 304, 306 and provides a compression fit with bone when thesuture anchor 300 is disposed in bone.

FIGS. 9-11A illustrate another embodiment of a suture anchor 400. FIG. 9illustrates the anchor 400 as a standalone element, and FIG. 10illustrates the anchor 400 with a suture 410 coupled thereto via asuture-engaging feature 408 at a distal end of the anchor 400 in theform of a fork. The anchor 400 is generally configured and used similarto the suture anchor 10 of FIGS. 1-2, but a groove 406 formed in anexterior surface of the anchor 400 in this illustrated embodiment is alinear groove extending longitudinally along the anchor's exteriorsurface, not a helical groove. FIG. 10 shows the suture 410 in a firstconfiguration, in which a first length 410 a of the suture 410 is seatedin the groove 406 and a second length 410 b of the suture 410 extendsalong the exterior surface of the anchor 400. FIG. 11A shows the suture410 in a second configuration, in which the first length 410 a of thesuture 410 is still seated in the groove 406 and the second length 410 bof the suture 410 is wrapped helically around the exterior surface ofthe anchor 400 and passes over the first length 410 a of the suture 410seated in the groove 406.

A diameter 410 d of the suture 410 is greater than a maximum depth 406 dof the groove 406 such that, similar to that discussed above regardingthe suture 12 being seated in the helical groove 16, the suture 410extends radially outward from the anchor 400. Thus, when the suture 410is in the second configuration, both the first and second lengths 410 a,410 b of the suture 410 can contribute to the suture 410 being in apress fit between the anchor 400 and a bone in which the anchor 400 isdisposed. The suture's diameter 410 d can, however, be equal to or lessthan the groove's maximum depth 406 d, in which case when the suture 410is in the second configuration only the second length 410 b of thesuture 410 would contribute to the suture 410 being in a press fitbetween the anchor 400 and a bone in which the anchor 400 is disposed.

Although the anchor 400 does not have a helical groove formed in itsexterior surface, the anchor 400 can have a helical groove formed in itsexterior surface configured to seat the second length 410 b of suture410 therein when the suture 410 is in the second configuration. Thehelical groove being present may help space out the winding of thesuture 410 as the suture 410 winds around the suture anchor 400. In anexemplary embodiment, the helical groove has a maximum depth that isless than the diameter 410 d of the suture 410 to allow the suture 410(e.g., the second length 410 b thereof that is seated in the helicalgroove) to be in a press fit when the suture anchor 400 is driven intobone.

FIG. 11B illustrates one embodiment of a suture anchor 500. The sutureanchor 500 is generally configured and used similar to the suture anchor400 of FIGS. 9-11A. The suture anchor 500 includes a helical groove 502and a linear groove 504 in an exterior surface thereof. Also shown inFIG. 11B is a proximal terminal end 502 p of the helical groove 502 fromwhich a suture seated in the helical groove 502 can proximally extend,an inner lumen 506 of the anchor 500 configured to receive a driver tooltherein, and a suture-engaging feature 508 at a distal end of the anchor400 in the form of an eyelet or notch. The reference arrow for thelinear groove 504 also points to a proximal terminal end of the lineargroove 504 from which a suture seated in the linear groove 504 canproximally extend.

In at least some embodiments, an exterior surface of a suture anchor canhave some texture or roughness to better hold onto the suture beingwound around the suture anchor. In other examples, a distal suturelength of the suture can be significantly longer than a proximal suturelength of the suture and can coil up tightly along an entire length ofthe suture anchor. In another embodiment, a distal suture length of afirst suture can wind around a second suture with no suture anchor atall. An inserter in this example can have sufficient torsional rigiditysuch that the inserter can wind up the distal suture length withoutbreaking. In various examples, the inserter can have a forked distal tipto surround a diameter of the distal suture length of the first suture.The inserter can be cannulated so that the second suture avoids beingwound up with the first suture. In other examples, the first and/orsecond suture can be pulled tight, allowing the first and/or secondsuture to be over-wound with the other suture. Such an arrangement canalso be dipped, sprayed, submerged, tipped, or otherwise exposed to asubstance that acts to stiffen fibers of the sutures. Having a sutureanchor without grooves or eliminating the suture anchor entirely mayallow for suture anchor walls to be extremely thin or nonexistent,reducing an overall footprint of any anchor and allowing less invasivecomponents to be used in a patient. The anchors 10, 30 of FIGS. 1-11Bhave circular cross-sectional shapes. Bone holes are typically formedwith a circular cross-sectional shape, so an anchor having a circularcross-sectional shape may help ensure that the anchor is securely seatedin the bone hole by helping to maximize contact of a suture wrappedhelically around the anchor with a wall of the bone hole. In otherembodiments, an anchor can have a non-circular cross-sectional shape.For example, an anchor having an interrupted helical groove can have anon-circular cross-sectional shape, which may facilitate manufacturingof the anchor. In an exemplary embodiment, the non-circularcross-sectional shape is symmetric, which may also facilitatemanufacturing of the anchor.

An anchor having an interrupted helical groove and having a non-circularcross-sectional shape can include a plurality of lobes. The groove canbe formed in the anchor's exterior surface by cutting the surface, suchas with a die. As the groove is cut into the anchor's exterior surface,only the highest parts of the anchor will be affected, namely theplurality of lobes. The groove will thus be formed in only the highestparts of the anchor, e.g., in only the lobes. The remaining exteriorsurface of the anchor will remain ungrooved. In various embodiments, thegroove can be linked (e.g., a single lead thread, etc.) or unlinked(e.g., a double-lead thread, etc.). For example, the groove on an anchorcan be interrupted but form a continuous pattern or shape across thelobes, or the groove can be interrupted and not form a continuouspattern between the lobes. A depth of the groove cut into the anchor canbe defined by a magnitude of a mis-match between the die (or othercutter being used to cut the groove). In an exemplary embodiment, aminor diameter of the thread in the die is a major diameter of an anchorshaft blank (e.g., the anchor piece not yet having the groove formedtherein), and a major diameter of the thread in the die is a minordiameter of the anchor shaft blank. Such a configuration may allow thedeepest groove to be cut on the lobes without any groove being formed inthe sides.

FIG. 12 shows one embodiment of a 2-lobed anchor 41 having an ovalcross-sectional shape with lobes 44 of the anchor 41 having a grooverunning along a length of the anchor 41 and non-grooved portions 42 ofthe anchor's exterior surface being smooth. FIG. 13 illustrates oneembodiment of a 3-lobed anchor 45 having a triangular cross-sectionalshape with grooved lobes 48 and ungrooved flat portions 46. FIG. 14illustrates one embodiment of a 4-lobed anchor 49 having a squarecross-sectional shape with grooved lobes 52 and ungrooved flat portions50.

In some embodiments, a suture anchor configured to seat a suture on anexterior surface thereof can have no helical groove at all in theexterior surface thereof. A suture can be configured to wrap around andcoil tightly along the suture anchor's exterior surface. In such anembodiment, an overall length of the suture can be much longer relativeto a suture used with a suture anchor having a helical groove(continuous or non-continuous) formed in an exterior surface thereof. Insuch an embodiment, an external surface of the suture anchor can havetexture or roughness thereon to allow the suture to better engage theexternal surface. In such an embodiment, a wall of the anchor can bevery thin since a groove need not be formed therein, thereby reducing anoverall footprint of the anchor.

Any of the anchors described herein can be pre-loaded with a suturecoupled thereto. A user of the anchor thus need not couple the suture tothe anchor but instead receive the anchor ready to use with the suturecoupled thereto.

One embodiment of a method of securing an anchor to bone is illustratedin FIGS. 15-21. FIGS. 15-21 illustrate another embodiment of a sutureanchor 100 that includes an inner lumen 102 extending therethrough andthat includes a helical groove 104. The suture anchor 100 is generallyconfigured and used similar to the suture anchor 10 of FIGS. 1-2. Asshown in FIG. 15, the suture anchor 100 is coupled to a suture 110. Thesuture anchor 100 has a first length of the suture 110 within the innerlumen 102 of the suture anchor 100, a second length of the suture 110extending outside an exterior surface of the suture anchor 100, and athird length of the suture 110 between the first and second lengths andseated in a suture-engaging feature 106 that is in communication withthe helical groove 104 on the external surface of the suture anchor 100.A distal end 112 d of a driver tool 112 is positioned within the innerlumen 102. The driver tool 112 has an inner lumen 114, and the suture110 (a proximal portion of the first length thereof extending proximallyout of the inner lumen 102) extends within the inner lumen 114 of thedriver tool 112. In other embodiments, the driver tool 112 can include agroove in an outer surface thereof configured to seat the suture 110therein instead of the suture 110 extending through the inner lumen 114,with such a driver tool need not including the inner lumen 114.

As shown in FIG. 15, a distal end 100 d of the suture anchor 100 ispositioned at a pre-drilled bone hole 120 in bone 122. The bone hole 120can be formed in any of a variety of ways, as will be appreciated by aperson skilled in the art, such as with a drill or an awl. A size of thebone hole 120 corresponds to a size of the anchor 100, e.g., a depth anda diameter of the bone hole 120 correspond to the length and diameter ofthe anchor 100 so the anchor 100 can be disposed within the bone hole120 with the suture 110 compression or press fit therein.

As the driver tool 112 is rotated and advanced distally, as shown inFIGS. 16-20, the suture anchor 100 is driven into the bone hole 120. Adirection of the rotation is a same direction of the helical shape ofthe groove 106, e.g., both counter-clockwise, to facilitate seating ofthe suture 110 within the groove 104 during the rotation of the drivertool 112. As illustrated in FIG. 16, as the suture anchor 100 is driveninto the bone hole 120 by the driver tool 112, the second length of thesuture 110 that extends outside the exterior surface of the sutureanchor 100 becomes seated within the helical groove 104 in adistal-to-proximal direction starting at the suture-engaging feature106. The portion of the suture 110 located outside of the anchor 100,e.g., the portion of the suture 110 extending radially outward from thegroove 104, is pressed against the wall of the bone hole 120 in acompression or press fit. As illustrated in the sequence of FIGS. 17-20,as the suture anchor 100 continues to be driven into the bone hole 120,the suture 110 continues to be seated in the helical groove 104 windingaround the suture anchor 100 from the distal end 100 d to the proximalend 100 p. When the suture anchor 100 is fully seated in the bone hole120, as shown in FIG. 20, the groove 104 contains the suture 110 thereinwith the suture 110 in a compression or press fit with the bone tosecure the anchor 100 and the suture 110 in position within the bonehole 120. The suture anchor 100 is fully seated in the bone hole 120with the suture anchor 100 substantially flush with a surface of thebone 122, but the suture anchor 100 can be below the surface of the bone122 or above the surface of the bone 122. With the anchor 100 driveninto the bone, the driver tool 112 is removed therefrom. FIG. 21illustrates the suture anchor 100 fully seated in the bone hole 120after the driver tool 112 has been removed.

A person skilled in the art will appreciate that the implementationsdescribed herein have application in conventional minimally-invasive andopen surgical instrumentation as well application in robotic-assistedsurgery.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical method, comprising: rotating a sutureanchor into bone with a suture seated in a suture-seating feature at adistal end of the suture anchor, the rotation causing the suture tohelically wrap around the suture anchor in a distal to proximaldirection and thereby be seated in a groove formed in an exteriorsurface of the suture anchor, the suture having a diameter that isgreater than a maximum depth of the groove such that the suture seatedin the groove protrudes radially outward from the groove.
 2. The methodof claim 1, wherein the groove is a single continuous groove.
 3. Themethod of claim 1, wherein the groove includes a plurality of discretegrooves that together define a helical path.
 4. The method of claim 1,wherein the suture-seating feature is continuous with the groove.
 5. Themethod of claim 1, wherein the suture-seating feature is not continuouswith the groove.
 6. The method of claim 1, wherein the suture-seatingfeature includes one of an eyelet, a recess, a fork, a bar, a notch, aloop, a hook, and a crimping feature.
 7. A surgical method, comprising:rotating a suture anchor into bone with a suture seated in asuture-seating feature at a distal end of the suture anchor, therotation causing the suture to move from a first configuration in whichat least a first length of the suture extends longitudinally outside anexterior surface of the suture anchor to a second configuration in whichthe first length of the suture wraps helically around the exteriorsurface of the suture anchor and is seated within a groove defining ahelical path around the exterior surface, the first length of the suturein the second configuration protruding radially outward from theexternal surface of the suture anchor.
 8. The method of claim 7, whereinthe groove includes a plurality of discrete grooves that together definethe helical path.
 9. The method of claim 7, wherein the suture-seatingfeature is continuous with the groove.
 10. The method of claim 7,wherein the suture-seating feature includes one of an eyelet, a recess,a fork, a bar, a notch, a loop, a hook, and a crimping feature.